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Complications after Breast Cancer Surgery and Oncological Outcomes
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.ORCID iD: 0000-0002-0880-2468
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Breast cancer is the most common cancer worldwide for females. A frequent complication following breast cancer surgery is surgical site infection (SSI). Complications can result in diminished quality of life, increased morbidity, elevated healthcare costs, delayed initiation of adjuvant therapy, loss of reconstruction, and potentially adverse oncological outcomes. In Paper I, the primary objective was to investigate the purported association between SSI and breast cancer recurrence. In addition, the study aimed to explore a potential link between any postoperative infection and breast cancer recurrence. This population-based, retrospective cohort study found that neither SSI nor other postoperative infections were associated with worse oncologic outcomes. Paper II investigated risk factors for SSI following breast cancer surgery, as well as risk factors for other wound complications. This research was conducted through a prospectively registered cohort study. Multivariable analysis identified BMI 25-30 and BMI >30 as the only significant risk factors for SSI. Additionally, significant risk factors for any wound complication included mastectomy with or without reconstruction, as well as BMI 25-30 and BMI >30. In Paper III, the primary aim was to evaluate whether SSI increases the risk of systemic breast cancer recurrence. Secondary objectives included assessing the impact of SSI on the risk of locoregional recurrence (LRR), breast cancer-specific survival (BCSS), and overall survival (OS). This analysis utilized high-quality data from national population-based registers, checking for confounding variables such as patient and tumour characteristics. In conclusion, SSI following breast cancer surgery does not significantly increase the risk of systemic recurrence, LRR, overall death, or breast cancer-specific death. Paper IV evaluated the risk of systemic breast cancer recurrence following major systemic postoperative infection or other major event. It also assessed the impact of these exposures on LRR, OS, and BCSS. Utilizing the same cohort as in Paper III, the findings indicated that postoperative major systemic infection was associated with an increased risk of systemic recurrence, overall death and breast cancer-specific death, but not with LRR.

In conclusion, this thesis does not support the hypothesis that SSI is associated with poorer oncological outcomes. However, it demonstrates an association between major systemic infections and worse oncological outcomes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2025. , p. 99
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2113
Keywords [en]
Breast cancer surgery, postoperative complications, surgical site infection, systemic infection, postoperative major event, risk factors, recurrence, survival, population-based
National Category
Surgery
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-544007ISBN: 978-91-513-2336-7 (print)OAI: oai:DiVA.org:uu-544007DiVA, id: diva2:1919651
Public defence
2025-02-07, H:son Holmdahlsalen, Akademiska sjukhuset, ing 100, våning 1, Dag Hammarskjölds Väg 8, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2025-01-17 Created: 2024-12-09 Last updated: 2025-01-17
List of papers
1. Association of postoperative infection and oncological outcome after breast cancer surgery
Open this publication in new window or tab >>Association of postoperative infection and oncological outcome after breast cancer surgery
2021 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 5, no 4, article id zrab052Article in journal (Refereed) Published
Abstract [en]

Background: Surgical-site infection (SSI) is a well known complication after breast cancer surgery and has been reported to be associated with cancer recurrence. The aim of this study was to investigate the association between SSI and breast cancer recurrence, adjusting for several known confounders. The secondary aim was to assess a possible association between any postoperative infection and breast cancer recurrence.

Method: This retrospective cohort study included all patients who underwent breast cancer surgery from January 2009 to December 2010 in the Uppsala region of Sweden. Data collected included patient, treatment and tumour characteristics, infection rates and outcome. Association between postoperative infection and oncological outcome was examined using Kaplan-Meier curves and Cox regression analysis.

Results: Some 492 patients (439 with invasive breast cancer) with a median follow-up of 8.4 years were included. Mean(s.d.) age was 62(13) years. Sixty-two (14.1 per cent) of those with invasive breast cancer had an SSI and 43 (9.8 per cent) had another postoperative infection. Some 26 patients had local recurrence; 55 had systemic recurrence. Systemic recurrence was significantly increased after SSI with simple analysis (log rank test, P = 0.035) but this was not observed on adjusted analysis. However, tumour size and lymph node status remained significant predictors for breast cancer recurrence on multiple regression. Other postoperative infections were not associated with recurrence.

Conclusion: Neither SSI nor other postoperative infections were associated with worse oncological outcome in this study. Rather, other factors that relate to both SSI and recurrence may be responsible for the association seen in previous studies.

Place, publisher, year, edition, pages
Oxford University PressOxford University Press (OUP), 2021
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-468367 (URN)10.1093/bjsopen/zrab052 (DOI)000754552400004 ()34240113 (PubMedID)
Funder
Göran Gustafsson Foundation for promotion of scientific research at Uppala University and Royal Institute of Technology
Available from: 2022-03-02 Created: 2022-03-02 Last updated: 2024-12-09Bibliographically approved
2. Prospective Evaluation of Complications and Associated Risk Factors in Breast Cancer Surgery
Open this publication in new window or tab >>Prospective Evaluation of Complications and Associated Risk Factors in Breast Cancer Surgery
2022 (English)In: Journal of Oncology, ISSN 1687-8450, E-ISSN 1687-8469, Vol. 2022, article id 6601066Article in journal (Refereed) Published
Abstract [en]

Background; Surgical site infection (SSI) is a well-known complication after breast cancer surgery. The primary aim was to assess risk factors for SSI. Risk factors for other wound complications were also studied.

Materials and Methods: In this prospectively registered cohort study, patients who underwent breast-conserving surgery (BCS) or mastectomy between May 2017 and May 2019 were included. Data included patient and treatment characteristics, infection, and wound complication rates. Risk factors for SSI and wound complications were analyzed with simple and multiple logistic regression.

Results: The study cohort consisted of 592 patients who underwent 707 procedures. There were 66 (9.3%) SSI and 95 (13.4%) wound complications. "BMI > 25, " "oncoplastic BCS, " "reoperation within 24 hour, " and "prolonged operative time " were risk factors for SSI with simple analysis. BMI 25-30 and > 30 remained as significant risk factors for SSI with adjusted analysis. Risk factors for "any wound complication " with adjusted analysis were "mastectomy with/without reconstruction " in addition to "BMI 25-30 " and "BMI > 30. "

Conclusion: The only significant risk factor for SSI on multivariable analysis were BMI 25-30 and BMI > 30. Significant risk factors for "any wound complication " on multivariable analysis were "mastectomy with/without reconstruction " as well as "BMI 25-30 " and "BMI > 30. "

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2022
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-486693 (URN)10.1155/2022/6601066 (DOI)000861616000004 ()
Funder
Uppsala University
Available from: 2022-10-17 Created: 2022-10-17 Last updated: 2024-12-09Bibliographically approved
3. Postoperative complications after breast cancer surgery and effect on recurrence and survival: population-based cohort study
Open this publication in new window or tab >>Postoperative complications after breast cancer surgery and effect on recurrence and survival: population-based cohort study
Show others...
2024 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 8, no 6, article id zrae137Article in journal (Refereed) Published
Abstract [en]

Background

There is conflicting evidence regarding whether postoperative complications after breast cancer surgery are associated with worse oncological outcome. This study aimed to assess the risk of systemic breast cancer recurrence after surgical site infection and also the impact of surgical site infection on locoregional recurrence, breast cancer-specific survival and overall survival.

Methods

This nationwide cohort study included patients who underwent surgery for primary breast cancer in Sweden between January 2008 and September 2019. The study cohort was identified in the Breast Cancer Database Sweden 3.0, a database linking the National Breast Cancer Quality Register to national population-based healthcare registers held by the National Board of Health and Welfare and Statistics Sweden. The primary exposure was surgical site infection within 90 days from surgery, and the primary outcome was systemic recurrence of breast cancer. Secondary outcomes included locoregional recurrence, overall survival and breast cancer-specific survival. Multivariable Cox regression analysis was performed to assess the association between exposure, predictors and outcomes.

Results

Of 82 102 patients included in the study, 15.7% experienced a surgical site infection within 90 days of surgery. Surgical site infection was not significantly associated with systemic recurrence, locoregional recurrence or breast cancer-specific survival after adjustment for confounding variables. Surgical site infection was significantly associated with worse overall survival, but the significant association disappeared in a sensitivity analysis excluding all patients with any kind of malignancy before breast cancer diagnosis.

Conclusion

Surgical site infection after breast cancer surgery does not significantly increase the risk of systemic recurrence. All possible actions should nevertheless be taken to reduce complication rates.

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-544006 (URN)10.1093/bjsopen/zrae137 (DOI)001377215100001 ()39673757 (PubMedID)2-s2.0-85212571234 (Scopus ID)
Funder
Percy Falks stiftelse för forskning beträffande prostatacancer och bröstcancer
Available from: 2024-11-27 Created: 2024-11-27 Last updated: 2025-01-09Bibliographically approved
4. Postoperative major systemic infection following breast cancer surgery associated with worse oncological outcomes
Open this publication in new window or tab >>Postoperative major systemic infection following breast cancer surgery associated with worse oncological outcomes
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-544004 (URN)
Available from: 2024-11-27 Created: 2024-11-27 Last updated: 2024-12-09

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